A group of people who have been given the same “diagnosis” and who need similar health care; for example, a group of people who have been called “depressed” or a group of people who have been called “sleep-disordered.” These groups are put together by insurance companies to help settle questions about payment.
A system for determining payments to hospitals, used under Medicare's prospective payment system (PPS) and by some other public and private payers. The DRG system classifies patients into groups based on the principal diagnosis, treatments, and other relevant criteria. Hospitals are paid the same for each case classified in the same DRG, regardless of the actual cost of treatment.
Patient classification system that relates demographic, diagnostic, and therapeutic characteristics of patients to length of inpatient stay and amount of resources consumed, that provides a framework for specifying hospital case mix, and that identifies 468 classifications of illnesses and injuries for which Medicare payment is made under the prospective pricing program.
Classification of patients by diagnosis or other criteria (such as treatment procedure) into groups for the purpose of determining a prospective payment for each group, based on the premise that treatment of similar diagnoses will generate similar costs.
A patient classification system developed by 3M for the Health Care Financing Administration (Medicare, Medicaid, Child Health). This is a code that specifies the diagnosis and the treatment for a case. It groups patients (really, billable events) into predefined categories.
A category of related diagnoses identified by health insurance plans and by Medicare, for which a hospital is paid a flat amount as part of the health plan coverage or Medicare's Prospective Payment System (PPS).
System involving classification of medical cases and payment to hospitals on the basis of diagnosis. Used under Medicare's prospective payment system to reimburse inpatient hospitals, regardless of the cost to the hospital to provide services.
Diagnosis-Related Group (DRG) is a system to classify hospital cases into one of approximately 500 groups, also referred to as DRGs, expected to have similar hospital resource use, developed for Medicare as part of the prospective payment system. DRGs are assigned by a "grouper" program based on ICD diagnoses, procedures, age, sex, and the presence of complications or comorbidities. DRGs have been used since 1983 to determine how much Medicare pays the hospital, since patients within each category are similar clinically and are expected to use the same level of hospital resources.